Date Published: April 21, 2009
Publisher: Public Library of Science
Author(s): Han W. Kim, Igor Klem, Dipan J. Shah, Edwin Wu, Sheridan N. Meyers, Michele A. Parker, Anna Lisa Crowley, Robert O. Bonow, Robert M. Judd, Raymond J. Kim, Anushka Patel
Abstract: Using delayed-enhancement cardiovascular magnetic resonance, Han Kim and colleagues show that in patients with suspected coronary disease the prevalence of unrecognized myocardial infarction without Q-waves is more than 3-fold higher than that with Q-waves and predicts subsequent mortality.
Partial Text: In patients with coronary artery disease (CAD), the diagnosis of myocardial infarction (MI) directs clinical management and affects prognosis. However, MI can be associated with atypical, minimal, or no symptoms and thus may occur “unrecognized” by the patients themselves and their physicians. Despite this unremarkable presentation, unrecognized MI (UMI) adversely affects prognosis with mortality rates that are similar to myocardial infarctions that are recognized clinically –.
This investigation is, to our knowledge, the first to systematically characterize the syndrome of unrecognized non-Q-wave myocardial infarction and demonstrate its prognostic importance. In a cohort without known prior MI referred for coronary angiography, one-third (62/185) had evidence of unrecognized MI by DE-CMR, among whom 80% (50/62) had no Q-waves. The presence of unrecognized non-Q-wave MI predicted a 11-fold higher risk of death and a 17-fold higher risk of cardiac death than those without MI.